Gynaecological cancers
Vaginal Cancer: Symptoms, Diagnosis and Treatment
Vaginal cancer is a rare type of gynaecological cancer that develops in the cells of the vagina. It is more commonly diagnosed in older women, although anyone with a vagina can develop the condition.
Because vaginal cancer is rare, many of its symptoms are more commonly caused by other, less serious conditions. However, unusual vaginal bleeding, persistent discharge, pain or a lump should always be checked by a GP or healthcare professional.
At Gynae Solution, we understand that being referred for investigation can be worrying. Our aim is to provide thorough specialist assessment, clear explanations and personalised care, helping you understand what is happening at every stage of your diagnosis and treatment.
What Is Vaginal Cancer?
The vagina is the muscular passage that connects the cervix, at the lower part of the womb, with the vulva.
Vaginal cancer develops when abnormal cells within the vagina begin to grow and divide in an uncontrolled way. There are several different types of vaginal cancer, depending on the type of cell in which the cancer begins.
The most common type is squamous cell carcinoma, which develops from the cells that line the surface of the vagina. Other, less common types include adenocarcinoma, melanoma and sarcoma.
Vaginal cancer is very rare, with around 300 women diagnosed in the UK each year. It is most commonly diagnosed in women over the age of 75 and is particularly uncommon in women under 40.
It is also important to distinguish primary vaginal cancer from cancer that has spread to the vagina from another part of the body, such as the cervix, womb, bowel or vulva.
Symptoms of Vaginal Cancer
Very early vaginal cancer may not cause any noticeable symptoms. When symptoms do occur, the most common is unusual vaginal bleeding.
Symptoms can include:
- Vaginal bleeding between periods
- Bleeding after sexual intercourse
- Vaginal bleeding after the menopause
- Unusual, blood-stained or unpleasant-smelling vaginal discharge
- Pain or discomfort during sexual intercourse
- A lump or growth within the vagina
- A persistent vaginal itch
- Pelvic pain or pressure
- Pain when passing urine
- Needing to urinate more frequently
- Blood in the urine
- Changes in bowel habits or difficulty emptying the bowel
- Swelling in the legs
Some symptoms, such as changes in bowel or bladder function or swelling of the legs, are more likely to occur when the cancer is more advanced.
These symptoms can be caused by many conditions that are not cancer. Having one or more of them does not mean that you have vaginal cancer. However, any unusual or persistent symptom should be assessed by your GP.
Particular attention should be paid to bleeding after the menopause or bleeding after sexual intercourse.
Causes and Risk Factors
In many cases, it is not possible to identify a single cause of vaginal cancer. However, certain factors can increase the risk of developing the condition.
These include:
- Increasing age
- Persistent infection with certain high-risk types of human papillomavirus (HPV)
- A previous diagnosis of cervical cancer or pre-cancerous cervical cell changes
- A weakened immune system
- HIV infection
- Smoking
- Previous exposure to the medication diethylstilbestrol (DES), which was used in pregnancy several decades ago
Persistent high-risk HPV infection is an important risk factor. HPV is extremely common and, in most people, the immune system clears the infection naturally. Having HPV does not mean that you will develop vaginal cancer.
Cervical screening does not specifically screen for vaginal cancer, as there is no national screening programme for vaginal cancer in the UK. However, cervical screening can identify HPV infection and abnormal cervical cell changes, which can help prevent cervical cancer and may identify some HPV-related abnormalities.
The HPV vaccination also helps protect against the types of HPV associated with several cancers, including vaginal cancer.
How Is Vaginal Cancer Diagnosed?
If you have symptoms that could be associated with vaginal cancer, your GP may refer you to a gynaecologist or specialist team for further assessment.
Your specialist will begin by discussing your symptoms, medical history and any previous investigations. A physical and pelvic examination may then be carried out.
Further investigations may include:
Vaginal Examination
A specialist will examine the vagina and surrounding tissues to look for any visible abnormalities, such as a lump, ulcer, area of unusual tissue or other changes.
The examination may also involve checking the cervix, vulva and surrounding pelvic structures.
Colposcopy
A colposcope is a specialist microscope that allows the vaginal tissues and cervix to be examined in greater detail. It can help identify areas that may require further investigation.
Biopsy
If an area appears abnormal, a small sample of tissue may be taken. This is called a biopsy.
The tissue is examined under a microscope by a specialist pathologist to determine whether abnormal or cancerous cells are present.
A biopsy is an important part of diagnosing vaginal cancer because imaging or examination alone cannot usually confirm whether an abnormal area is cancerous.
Imaging
If cancer is diagnosed, further scans may be recommended to understand the size and location of the tumour and determine whether it has spread to nearby tissues or other parts of the body.
Depending on your circumstances, this may include an MRI scan, CT scan or other appropriate imaging.
Staging and Grading
If vaginal cancer is confirmed, your specialist team will determine its stage and grade.
The stage describes the size of the cancer and whether it has spread beyond the vagina. The grade describes how abnormal the cancer cells look under a microscope and can provide information about how the cancer may behave.
This information is important when deciding which treatment is most appropriate for you.
Treatment Options
Treatment for vaginal cancer depends on several factors, including the type of cancer, its size and location, the stage and grade, whether it has spread and your general health.
Treatment may include surgery, radiotherapy, chemotherapy or a combination of treatments. Your care will normally be planned by a specialist multidisciplinary team, who will consider your individual circumstances when recommending treatment.
Radiotherapy
Radiotherapy is one of the main treatments for vaginal cancer and may be recommended as the primary treatment, following surgery or when surgery is not appropriate.
It uses high-energy radiation to destroy cancer cells.
Radiotherapy may be delivered externally, using a machine outside the body, or internally through a treatment called brachytherapy, where radiation is delivered directly to the affected area.
In some circumstances, radiotherapy may be combined with chemotherapy.
Surgery
Surgery may be appropriate for selected patients, depending on the size and position of the cancer.
The type of surgery required will vary. It may involve removing the tumour with a margin of healthy tissue, known as a wide local excision. More extensive surgery, including removal of part or all of the vagina, may be considered for some patients.
In complex cases, reconstructive surgery may also be discussed.
The potential impact of surgery on sexual function, fertility, physical wellbeing and quality of life will be discussed with you before treatment.
Chemotherapy
Chemotherapy uses anti-cancer medicines to destroy cancer cells or prevent them from growing.
For vaginal cancer, chemotherapy is often used alongside radiotherapy, known as chemoradiotherapy. It may also be considered on its own in certain circumstances, particularly when cancer has returned or has spread to other parts of the body.
Clinical Trials
For some patients, participation in a clinical trial may be an option. Clinical trials can provide access to new or developing treatments and help improve understanding of vaginal cancer.
If a clinical trial may be appropriate, your specialist team can discuss this with you.
Recovery and Aftercare
Recovery from vaginal cancer treatment varies depending on the treatment you receive and your individual circumstances.
Following surgery, you will receive detailed advice about your recovery, including wound care, managing discomfort and gradually returning to normal activities.
Radiotherapy and chemotherapy can also cause side effects, and these may continue for some time after treatment has finished. Your specialist team will explain what you can expect and how any side effects can be managed.
Follow-up appointments are an important part of your aftercare. Initially, these may take place every few months so that your specialist team can monitor your recovery and look for any signs of recurrence.
Treatment can also affect areas of your life that may be difficult to discuss, including sexual health, intimacy, fertility, bladder or bowel function and emotional wellbeing.
These concerns are an important part of your overall recovery. You should feel able to discuss them openly with your healthcare team and ask for additional support where needed.
Risks and Benefits of Treatment
Every treatment has potential benefits and risks, and these will vary depending on the treatment recommended and your individual circumstances.
The potential benefits of treatment may include removing or controlling the cancer, reducing symptoms, preventing the cancer from spreading and improving long-term outcomes.
The risks will depend on the treatment you receive.
Surgery can carry general risks such as bleeding, infection, blood clots and complications associated with anaesthesia. More extensive surgery may also affect surrounding organs, sexual function or quality of life.
Radiotherapy can cause side effects affecting the vaginal tissues, bladder or bowel, while chemotherapy can cause side effects such as tiredness, nausea and increased susceptibility to infection.
Some treatments can have longer-term effects on sexual health, fertility and vaginal function. Your specialist will discuss these considerations with you before treatment begins.
The aim is to ensure that you understand both the potential benefits and risks of your treatment and have the opportunity to ask questions before making an informed decision about your care.
Specialist Vaginal Cancer Care
Being referred for investigation because of unusual vaginal bleeding, discharge or another symptom can understandably be unsettling. However, these symptoms are common and are often caused by conditions other than cancer.
At Gynae Solution, we believe that patients should have access to clear information, specialist expertise and compassionate care throughout their journey.
Mr Jafaru Abu will take the time to understand your symptoms, explain the investigations recommended and discuss your diagnosis and treatment options with you.
If you are experiencing unusual or persistent vaginal symptoms, or have been referred for further investigation, contact Gynae Solution to arrange a consultation with Mr Jafaru Abu.
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